Vanherweghem J L, Depierreux M, Tielemans C, Abramowicz D, Dratwa M, Jadoul M, Richard C, Vandervelde D, Verbeelen D, Vanhaelen-Fastre R
Department of Nephrology, Université Libre de Bruselles, Belgium.
Lancet. 1993 Feb 13;341(8842):387-91. doi: 10.1016/0140-6736(93)92984-2.
Two similar cases of rapidly progressive fibrosing interstitial nephritis in young women who followed the same slimming regimen prompted us to conduct an epidemiological survey of the nephrology centres of Brussels and to further investigate the exact nature of this slimming treatment. Seven other women under the age of 50 in terminal or preterminal renal failure were admitted for dialysis in 1991 and 1992. They had all followed a slimming regimen in the same medical clinic. Renal biopsy samples in eight of the nine cases showed extensive interstitial fibrosis without glomerular lesions. Two of the patients were seen for the first time in terminal renal failure and were started immediately on dialysis. For the seven other women, the nephropathy was characterised by a rapid deterioration in renal function, with initial serum creatinine doubling within about 3 months. The clinic had specialised in slimming treatments for the previous 15 years without any problems. In May, 1990, therapy was changed, with the introduction of two Chinese herbs (Stephania tetrandra and Magnolia officinalis). In June, 1992, three of twenty-five randomly selected women who had followed the same regimen during at least 3 months from 1990 had impaired renal function. Chemical analysis of some brands of these Chinese herbs did not show nephrotoxic contaminants of fungal or plant origin (ochratoxin or aristolochic acid) or adulteration by diuretics or antiinflammatory drugs. However, the medicinal preparation of the capsules taken by patients had different alkaloid profiles from those expected in Chinese plants. The striking relation between a specific type of fibrosing interstitial nephritis in young women and a slimming treatment involving Chinese herbs adds support to the arguments against uncontrolled therapy with herbal preparations.
两名年轻女性患有快速进展性纤维化间质性肾炎，她们采用了相同的减肥方案，这促使我们对布鲁塞尔的肾病中心进行了一项流行病学调查，并进一步调查这种减肥疗法的确切性质。1991年和1992年，另外7名年龄在50岁以下处于终末期或终末期前肾衰竭的女性因透析入院。她们都在同一家诊所采用了减肥方案。9例病例中有8例的肾活检样本显示广泛的间质纤维化，无肾小球病变。其中两名患者首次就诊时已处于终末期肾衰竭，立即开始透析。另外7名女性的肾病特征是肾功能迅速恶化，最初血清肌酐在约3个月内翻倍。该诊所在过去15年一直专门从事减肥治疗，此前没有任何问题。1990年5月，治疗方法发生了改变，引入了两种中草药（防己和厚朴）。1992年6月，在1990年至少3个月内采用相同方案的25名随机挑选的女性中，有3名肾功能受损。对这些中草药某些品牌的化学分析未显示出真菌或植物来源的肾毒性污染物（赭曲霉毒素或马兜铃酸），也未发现利尿剂或抗炎药的掺假情况。然而，患者服用的胶囊剂药物制剂的生物碱谱与中国植物中预期的不同。年轻女性中特定类型的纤维化间质性肾炎与一种涉及中草药的减肥疗法之间的显著关联，为反对无节制使用草药制剂治疗的观点提供了支持。
